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Rothrock & Associates
Financial, Inc.
580 Village Blvd., Suite 380
West Palm Beach,  Florida 33409
Tel: 561-471-8781
Fax: 561-688-2788
Email:  info@rothrockins.com


Boat & Personal Watercraft Insurance Quote

First & Last Name:  
Street Address:  
City, State & Zip:  
E-Mail Address:  
Telephone:  
Fax:  

Current Insurance Information
Insurance Company Name:  
Policy Exp. Date:  
Premium Amt:  
Term:  
How long with current?  

Boat Information
Boat Year:  
Length:  
Max Speed:  
# of motors:  
Manufacturer:  
Registration #:  
Purchase Price:  
Present Value:  
Hull construction:  
Total Horsepower:  
Engine:  
Trailer Year:  
Trailer Value:  
Trailer Make/Model:  
Storage Address:  

Protection & Indemnity Limits:  

Years Owning:  
Years Experience:  

Add any additional information that may assist us in your watercraft quote including coverages and/or coverage for yachts, personal watercraft or jet skis:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentially viewed by unauthorized others. We will only use this information for insurance quoting purposes and not distribute to other parties.

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